|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL RETINACULUM
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$586.45 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.10
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$586.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 25115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.58 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,263.05
|
| Rate for Payer: BCN Commercial |
$2,263.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$806.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$733.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER
|
Facility
|
OP
|
$8,813.49
|
|
|
Service Code
|
CPT 21936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,380.49 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,874.25
|
| Rate for Payer: BCN Commercial |
$1,874.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,518.54
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$1,380.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER
|
Facility
|
OP
|
$8,813.49
|
|
|
Service Code
|
CPT 21558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,303.35 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,874.25
|
| Rate for Payer: BCN Commercial |
$1,874.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,433.68
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$1,303.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
RADICAL RESECTION OF TUMOR, METACARPAL
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,032.77 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.05
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$1,032.77
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 1 VIEW
|
Facility
|
OP
|
$271.13
|
|
|
Service Code
|
CPT 73501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$271.13 |
| Rate for Payer: Aetna Medicare |
$89.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$49.26
|
| Rate for Payer: BCN Commercial |
$49.26
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Nomi Health Commercial |
$258.81
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.13
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$216.90
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$30.23
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
OP
|
$4,731.27
|
|
|
Service Code
|
NDC 10858008107
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,750.57 |
| Max. Negotiated Rate |
$4,258.14 |
| Rate for Payer: Aetna American Axle |
$3,075.33
|
| Rate for Payer: Aetna Commercial |
$4,021.58
|
| Rate for Payer: Aetna Medicare |
$2,365.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.33
|
| Rate for Payer: BCBS Complete |
$1,892.51
|
| Rate for Payer: Cash Price |
$3,785.02
|
| Rate for Payer: Cofinity Commercial |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,311.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.02
|
| Rate for Payer: Healthscope Commercial |
$4,258.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,021.58
|
| Rate for Payer: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.33
|
| Rate for Payer: Priority Health SBD |
$2,980.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,750.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.45
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
OP
|
$473.13
|
|
|
Service Code
|
NDC 10858008110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$425.82 |
| Rate for Payer: Aetna American Axle |
$307.53
|
| Rate for Payer: Aetna Commercial |
$402.16
|
| Rate for Payer: Aetna Medicare |
$236.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: BCBS Complete |
$189.25
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cofinity Commercial |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.50
|
| Rate for Payer: Healthscope Commercial |
$425.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.16
|
| Rate for Payer: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.53
|
| Rate for Payer: Priority Health SBD |
$298.07
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.85
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
IP
|
$473.13
|
|
|
Service Code
|
NDC 10858008110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.18 |
| Max. Negotiated Rate |
$425.82 |
| Rate for Payer: Aetna American Axle |
$307.53
|
| Rate for Payer: Aetna Commercial |
$402.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cofinity Commercial |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.50
|
| Rate for Payer: Healthscope Commercial |
$425.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.16
|
| Rate for Payer: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.53
|
| Rate for Payer: Priority Health SBD |
$298.07
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.85
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
IP
|
$4,731.27
|
|
|
Service Code
|
NDC 10858008107
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,081.76 |
| Max. Negotiated Rate |
$4,258.14 |
| Rate for Payer: Aetna American Axle |
$3,075.33
|
| Rate for Payer: Aetna Commercial |
$4,021.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.33
|
| Rate for Payer: Cash Price |
$3,785.02
|
| Rate for Payer: Cofinity Commercial |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,311.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.02
|
| Rate for Payer: Healthscope Commercial |
$4,258.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,021.58
|
| Rate for Payer: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.33
|
| Rate for Payer: Priority Health SBD |
$2,980.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.45
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$111.72
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$100.55 |
| Rate for Payer: Aetna American Axle |
$72.62
|
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Aetna Medicare |
$55.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.62
|
| Rate for Payer: BCBS Complete |
$44.69
|
| Rate for Payer: Cash Price |
$89.38
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.38
|
| Rate for Payer: Healthscope Commercial |
$100.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.96
|
| Rate for Payer: PHP Commercial |
$94.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.62
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$41.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.79
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.98
|
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.63
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$100.08
|
|
|
Service Code
|
NDC 66993066130
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna American Axle |
$65.05
|
| Rate for Payer: Aetna Commercial |
$85.07
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.05
|
| Rate for Payer: BCBS Complete |
$40.03
|
| Rate for Payer: Cash Price |
$80.06
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.07
|
| Rate for Payer: PHP Commercial |
$85.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.05
|
| Rate for Payer: Priority Health SBD |
$63.05
|
| Rate for Payer: UMR Bronson Commercial |
$37.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.06
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$310.65
|
|
|
Service Code
|
NDC 69097082507
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Commercial |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.92
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UMR Bronson Commercial |
$136.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$100.08
|
|
|
Service Code
|
NDC 66993066130
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna American Axle |
$65.05
|
| Rate for Payer: Aetna Commercial |
$85.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.05
|
| Rate for Payer: Cash Price |
$80.06
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.07
|
| Rate for Payer: PHP Commercial |
$85.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.05
|
| Rate for Payer: Priority Health SBD |
$63.05
|
| Rate for Payer: UMR Bronson Commercial |
$44.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.06
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna Medicare |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$34.85
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.63
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UMR Bronson Commercial |
$32.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$111.72
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$100.55 |
| Rate for Payer: Aetna American Axle |
$72.62
|
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.62
|
| Rate for Payer: Cash Price |
$89.38
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.38
|
| Rate for Payer: Healthscope Commercial |
$100.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.96
|
| Rate for Payer: PHP Commercial |
$94.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.62
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$49.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.79
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$310.65
|
|
|
Service Code
|
NDC 69097082507
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna Medicare |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: BCBS Complete |
$124.26
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Commercial |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.92
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,169.52 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna American Axle |
$4,682.25
|
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,682.25
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$5,042.42
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,042.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,042.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health SBD |
$4,538.18
|
| Rate for Payer: UMR Bronson Commercial |
$3,169.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,665.28 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna American Axle |
$4,682.25
|
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: Aetna Medicare |
$3,601.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,682.25
|
| Rate for Payer: BCBS Complete |
$2,881.38
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$5,042.42
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,042.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,042.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health SBD |
$4,538.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,665.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 65862047701
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65862047701
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UMR Bronson Commercial |
$36.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna Medicare |
$41.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: BCBS Complete |
$32.83
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UMR Bronson Commercial |
$30.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
